Why we Britons are so depressed, despite all those happy pills
WHAT is wrong with this country? I mean that quite seriously. Something clearly is not right because, according to new statistics, people in the UK are among the most depressed in the Western world.
The data from the Organisation for Economic Co-operation and development ( OECd) showed that our rates of depression are more than double those of countries such as Poland, Greece, Italy and the Slovak Republic. And that is despite this country having a relatively high standard of living.
I think this is a fascinating finding that tells us a lot about how so much of what we think about depression is wrong.
Consider this: we have some of the highest rates of antidepressant prescribing in the world — and this is rising. The nHS issued 64.7 million prescriptions for antidepressants last year, double the amount from a decade ago. Yet research also shows people are getting more depressed, not less. So what is going on?
The problem, I think, is that the way we understand depression has been dominated in recent years by the idea that it’s just a chemical mishap in the brain; a random imbalance of chemicals.
This has been fuelled by the pharmaceutical industry, which with the development of SSRIs (a group of antidepressants, including Prozac, which are now the most commonly prescribed) has propagated the idea that depression can be treated with pills.
But if depression is simply a chemical mishap, then we wouldn’t be seeing these raised figures. In countries where prescription rates for antidepressants are high, there would be low levels of depression, as it would be being treated — just as countries with high rates of statin prescriptions see low cholesterol levels in the population.
If you look at it this way, given our high prescription rate we should have nailed depression in the UK. But clearly we haven’t.
And that’s because while brain chemicals are doubtless involved, clearly there are social and cultural factors, too. However, with the dominance of the biological model, this is too often ignored.
There is no doubt that the biological theory may help explain what’s happened to patients whose depression seems to come out of nowhere; an inexplicable black cloud which nothing and no one is able to shift.
It seems baffling and perplexing because they seem to have pleasant and stable lives, yet are suddenly incapacitated for no apparent reason. But there are the others I treat whose depression does seem to make sense.
I remember being asked to see a middle-aged woman who’d come into A&E because she was so depressed she’d stopped eating and drinking.
She was a shell of a human being, totally exhausted and devastated by her depression. She’d previously been admitted for it and little seemed to make it better. She was so depressed she could hardly be bothered to look up.
It transpired it was the anniversary of the deaths of her husband and two children, caused when she had momentarily fallen asleep at the wheel of the family car.
Is what she was experiencing a problem with her brain chemistry? As I listened to her story, her voice thin and distant, her eyes dead and hollow, I asked myself what other possible response there could be to what had happened.
Wasn’t her depression a normal response to something unimaginably horrendous?
I’ve thought the same when I’ve worked with patients with depression who’ve survived genocide and seen terrible atrocities, or at the less extreme end of the scale, the single mum who’s living in a highrise with screaming kids, trying to make do on a minimum wage job.
Can we really sum up their illness as a chemical imbalance that pills can cure?
THE reason, I think, that we as a nation are more depressed than others isn’t because of a quirk in biology: it’s social. And a large part of it is our high expectation for our lives.
We believe we should have the perfect life and be happy all the time. This puts us under incredible pressure and, in striving to be perfect, we fail, making ourselves miserable. Other societies take a more pragmatic approach and, ironically, as a result are more relaxed and happy.
So the answer isn’t to reach for the prescription pad, but to look at our lives and the pressures we put on ourselves and our children.
That is not to say that antidepressants don’t work. Rather, it’s that we do people with depression a disservice if we insist that the biological model of depression is the only one that’s relevant. For it means we fail to see people holistically or take into account what has happened in their lives.
When depression is seen like this, it’s clear tablets are not always the answer.